Looking up INS & CDC info regarding 72 or 96 hrs rotation of peripheral iv sites. I know in the past INS recommended only changing to 96 hrs if your institution could document its phlebitis rate - Is this still the case? Most CDC info indicates that the research does not show a difference between 72hr and 96hr - I cannot find specifics in the INS Standard of Practice or INS Polices and Procedure guidelines for 2011. Does anyone have more specific references? Also there are differences b/w CDC and INS standards w/ other situations like tubing changes - which source do you go with when this is the case - INS or CDC or a combination of both?
First peripheral catheter removal - INS removed the reference to a specific rate of phleitis inthe 2006 edition and it is not in the 2011 edition either. INS no longer states a specific number of days or hours for catheter removal. Instread removal should be when it is clinially indicated. In other words, removal is required when there is any type of sign or symptom of any complication. This is based on several randomized trials showing that complication rates are the same when two groups are comparing, one with a change at a specific time and the other group with a change only when clinically indicated.
CDC states 72 to 96 hours to reduce risk of infection and states that change based on clinical indications is an unresolved issue. The bottom line is we are moving away from a definitive length of time that a peripheral catheter should be allowed to remain in place. Instread all catheter should be removed immediately when there is any complaint of any problem. If your facility so chooses, you can leave your practice guidelines to change the catheter at 96 hours - your choise. The references are al listed in the INS standards of practice for catheter removal.
For IV set changes, both CDC and INS state that continuous set changes should be no more frequently thn 96 hours. CDC does allow you to go to 7 days if you choose that. But you should check with the set manufacturer for their statements about length of use for 7 days. The difference is intermittent sets. I consider the CDC statement about changing intermittet sets as an unresolved issue to be a great step forward. INS has always said change at 24 hours. This is based on the fact that both ends of the set is being manipulated with each dose. The fact is that there is absolutely no data on contamination of these sets during use. That is the basis for CDC's unreolved issue status. CDC also says that all catheters require access ONLY with a sterile device. No one would ever be able to convince me that using an intermittent set longer than 24 hours is using a sterile device. They may be contaminated after 1 use, we simply do not know since studies are not available on this issue.
Please remember that CDC guidelines are assessing only the risk of infection whereas INS is considering all complications CDC will not make any statements unless there is evidence to support it. INS uses a ranking system that includes all types of studies including some lower levels of studies that woul not get the attention of CDC.
In a legal case, both documents are used to establish the standard of care, which is what any reasonable and prudent nurse would do in the same or similar situation. For your policies, procedures, and practice guidelines, you must consider variables that are specific to your facility such as patient populations served and staff skills. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861